Lumbopelvic Final Exam

For the lumbars, rank these set up according to which provides the most rotation first, and which provides the most extension last:

A) Side posture push

B) Single hand contact KC

C) Side posture pull (coronal facets-speed)

D) Double thumb

E) Single hand contact Prone

TQ

Rotation

C - SP-pull

D - DTH

A - SP-push

E - SHC-P

B - SHC-KC

Extension

For the pelvis, rank these set up according to which provides the most rotation first, and which provides the most extension last:

A) Side posture pull

B) Prone Thompson

C) Side posture push & ISD

D) Prone Diversified

TQ

Rotation

A - SP-pull

C - SP-push & ISD

D - P Div

B - P Thomp

Extension

In the pelvis, what set-up is best done speedy for skinny patients?

Side posture pull

(rotation!)

In the pelvis, what set-up is best for bigger patients? How about sacrum?

Side posture PUSH

ISD for sacrum

What 3 listings are pushes preferred? What listing is pull preferred?

AS

IN

PI

Ex = pull

How do you decide to adjust ilium or sacrum?

Always adjust what is most POSTERIOR

If the SI joint is fixed on the same side as sacrum on the PI side, then what do you adjust?

TQ

PI ilium since more posterior

If the SI joint is fixed on the same side as sacrum on the AS side, then what do you adjust?

TQ

Adjust sacrum (posterior)

-- since Ilium is AS (anterior and superior)

What are 5 contraindications for adjusting?

TQ

1) Hypermobility of the articulation

2) Bone destructive pathology (Fracture/malignancy)

3) Inability of the patient to assume the adjustment position

4) Myelopathy, cauda equina

5) Spondylolisthesis

What are 9 cautions for adjusting?

TQ

1) CV insufficiency

2) Systemic arthridities

3) Detached retina

4) Congenital anomalies

5) Foraminal spurring

6) Degenerative joint disease

7) Disc herniation or rupture

8) Prostheses

9) Recent Surgery

What is the MIST acronym for documentation?

Medications

Illness

Surgery

Trauma

What is the OPQRST acronym for documentation?

Onset

Provocation

Quality

Radiating

Severity

Timing

During thrust, you should thrust _____ the articulation for an EX and ______ the articulation for IN

UP = EX

DOWN = IN

In a modified toggle thrust, there should be minimal and equal elbow bend, a _______ arch in the CH, a wrap around placement for the ______, accommodation of the body/shoulders to angle to the joint, and a _______set with a _______ release.

SOFT arch in CH

Wrap around SH placement

QUICK set & SLOW release

What is the only set-up that uses a high arch?

TQ

LAL/LAR

What is the CH for all Prone Diversified procedures, except for prone sacrum?

Superior Hand

What is the CH for Prone diversified Sacrum listings, such as PI-R/L or P-R/L?

Inferior Hand

(ONLY ONE)

For prone diversified, the superior edge of the pelvic piece on the Hylo should be placed just below the ______ of the patient.

ASIS

What is the CP for all Prone Diversified procedures EXCEPT for external coccyx?

#1b

What is the CP for external coccyx (AR or AL)?

(TQ on coccyx)

#9

(of superior hand)

What is the Stab for all Prone Diversified procedures except external coccyx?

SH thumb and fingers wrap around CH wrist

What is the Stab for External Coccyx?

(TQ on coccyx)

Inferior 1b on superior thumb w/ elbow fossa's in opposition of eachother

What is the DS for AS Prone Diversified?

Straightaway OPPOSITE side of involvement

(ex: R AS = L straightaway)

What is the TP for AS Prone Diversified?

S-I

(CH pointing down towards feet)

What is the SCP for AS Prone Diversified?

Superior Ischial tuberosity

What is the LOC for AS Prone Diversified?

S-I & P-A

What is the DS for PI Prone Diversified?

Scissored stance on OPPOSITE side

(Ex: L PI = R scissor stance)

What is the TP for PI Prone Diversified?

I-S

(CH toward shoulder on side of involvement)

What is the SCP for PI Prone Diversified?

Medial inferior aspect of PSIS

What is the LOC for PI Prone Diversified?

I-S & P-A

What is the DS for EX Prone Diversified?

Inferior open stance on SAME side of involvement

(ex: R EX = R open stance)

What is the TP for EX Prone Diversified?

L-M & I-S

(CH towards patients opposite iliac crest)

What is the SCP for EX Prone Diversified?

Lateral inferior aspect of PSIS

What is the LOC for EX Prone Diversified?

L-M, I-S, slight P-A

What is the DS for IN Prone Diversified?

Superior open stance on OPPOSITE side

(ex: L IN = R superior open stance)

What is the TP for IN Prone Diversified?

S-I & M-L

(CH pointing towards patients acetabulum on side of involvement)

What is the SCP for IN Prone Diversified?

Medial superior aspect of PSIS

What is the LOC for IN Prone Diversified?

M-L, S-I, P-A

What is the DS for Base Posterior Prone Diversified?

Straightaway on either side of patient

What is the TP for BP Prone Diversified?

I-S

(CH facing down towards feet)

What is the SCP for BP Prone Diversified?

S2

What is the LOC for BP Prone Diversified?

P-A through plane of 5th lumbar disc

What is the difference between BP and BP w/ spondy?

Same as BP but w/ an S-I TP (NOT I-S TP)

-- reduces stress on facet joint

What is the DS for Sacrum (PI-L/R; P-L/R) Prone Diversified?

(TQ on Sacrum Div)

Straightaway on OPPOSTIE side of sacrum involvement

(ex: PI-R = straightaway on L)

What is the TP for Sacrum (PI-L/R; P-L/R) Prone Diversified?

(TQ on Sacrum Div)

M-L

What is the SCP for Sacrum (PI-L/R; P-L/R) Prone Diversified?

(TQ on Sacrum Div)

Sacral ala

What is the LOC for Sacrum (PI-L/R; P-L/R) Prone Diversified?

(TQ on Sacrum Div)

P-L in accordance w/ SI joint articulation

What is the Torque for Sacrum (PI-L/R) Prone Diversified?

(TQ on Sacrum Div)

PI-R = CCW

PI-L = CW

When doing Sacrum Prone, you should step back for a ______ shaped pelvis, and step over for a more ______ shaped pelvis.

(TQ on Sacrum Div)

Step back = Female

Step over = Male

What is the DS for External coccyx Prone Diversified?

(TQ on coccyx)

Straightaway on OPPOSITE side of involvement

(Ex: AR = L straightaway)

What is the TP for External coccyx Prone Diversified?

(TQ on coccyx)

I-S

What is the SCP for External coccyx Prone Diversified?

(TQ on coccyx)

Base of coccyx favoring side of listing

What is the LOC for External coccyx Prone Diversified?

(TQ on coccyx)

I-S w/ arching thrust following contour of sacrum

What is the TQ for External coccyx Prone Diversified?

(TQ on coccyx)

AR = CCW

AL = CW

What are 4 indications of needing a coccyx adjustment?

(TQ on coccyx)

1) Sharp low pain, usually upon standing

2) rule out other causes of pain (ex: hemorrhoids)

3) Injury onset usually

4) X-ray to confirm if tip of coccyx anterior

For internal coccyx, the patient lays either side w/ knees flexed and the Dr is posterior to patient and takes distal tip of the ________ finger of the ________ hand and very slowly inserts until reaches internal surface of coccyx. A firm but restrained pressure applied w/ pressure held for _____ seconds and slowly release and withdraw finger while they bear down

Middle finger

Inferior hand

10 seconds

What is the special modification to PP for an LAL/LAR adjustment?

(TQ on LAL/LAR)

Pelvic piece raised extremely high to enable the doctor to get an A-P LOD

What is the DS for LAL/LAR Prone Diversified?

(TQ on LAL/LAR)

Inferior stance on SAME side of involvement (very low)

(ex: LAR = R side)

What is the TP for LAL/LAR Prone Diversified?

(TQ on LAL/LAR)

I-S

What is the SCP for LAL/LAR Prone Diversified?

(TQ on LAL/LAR)

Sacral notch on side of involvement (slightly lateral to apex of sacrum)

What is the LOC for LAL/LAR Prone Diversified?

A-P & I-S

What is the TQ for LAL/LAR Prone Diversified?

(TQ on LAL/LAR)

LAL = CW

LAR = CCW

(Up the articulation)

T/F: There are no compound procedures in diversified prone, you have to do 2 different procedures

TRUE

When perfomring a Derifield leg check, if you have a short L leg that goes long upon flexion, what is the listing?

+D on L

(TQ on +D)

When performing a Derifield leg check, if you have a short L leg that stays short upon flexion, what is the listing?

-D on L

NOTE: There will be a TQ on -D (either part 1, 2, or alternate)

When performing a Derifield leg check, a +D leg check could indicate a _____ ilium and a +D Thompson adjustment.

(TQ on +D)

PI ilium

When performing a Derifield leg check, a -D leg check could indicate a ____________ sacrum, which can be adjusted through -D part 1 & 2, -D alternate, or LAL/LAR?

Anterior Inferior Sacrum

What would the listing be for a sacral leg check with the R leg going 6 inches or higher than the L leg.

SAR

What are the only 2 Thompson set ups that have torque?

EX & IN

What is the Leg check order for Thompson?

1) Cervical Derifield leg check

2) Pelvic derifiled leg check

3) SAL/SAR leg check

What are the 3 stabilization options used in Thompson?

1) ASIS

2) Thumb web

3) Heel of hand

What is the only Thompson set up that has a drop towards the feet?

PIIN

What 3 Thompson set ups have a drop towards the head?

1) PIEX

2) -D part 1

3) -D alternate

What are the 3 Thompson set ups that have a drop towards the floor?

1) +D

2) SAL/SAR

3) -D part 2

What is the PP for all Thompson procedures except for -D part 1 & 2?

Prone

What is the PP for -D part 1 & 2 Thompson?

Supine

What is the CP for all Thompson maneuvers except -D part 1 & 2 & alternate?

1b

What is the CP for -D part 1?

#7 on Inferior hand

#11 on Superior hand

What is the CP for -D part 2?

#10a

What is the CP for -D alternate?

# 11 on Inferior

#1 on Superior

What is the CH for PIIN & +D Thompson maneuvers?

(TQ on +D)

Inferior hand

What is the CH for PIEX Thompson?

Superior Hand

What is the CH for SAL/SAR?, -D part 1 & part 2, and -D alternate?

Dual contact hand (both!)

What is the DS for +D Thompson?

(TQ on +D)

Scissored inferior to articulation OPPOSITE side of involvement

What is the TP for +D Thompson?

(TQ on +D)

I-S

What is the SCP +D Thompson?

(TQ on +D)

Inferior medial PSIS

What is the LOC for +D Thompson?

(TQ on +D)

P-A & I-S

What is the difference in hand placement between +D Thompson and PIIN Thompson?

(TQ on +D)

Fingers pointing towards same iliac crest

(NOTE: rest of stance and SCP/contacts the SAME)

What is the LOC for PIIN Thompson?

P-A, I-S, M-L

What is the TQ for PIIN Thompson?

Down articulation

R = CCW

L = CW

What is the DS for PIEX Thompson?

Scissored inferior to articulation on SAME side of involvement

What is the TP for PIEX Thompson?

I-S & L-M

What is the SCP for PIEX Thompson?

Lateral inferior aspect of the PSIS

What is the LOC for PIEX Thompson?

P-A, I-S, L-M

What is the TQ for PIEX Thompson?

Up the articulation

R = CW

L = CCW

What is the unique PP for SAR/SAL Thompson?

Leg opposite the side of apex deviation crossed over other leg at knee

(Ex: if SAR we standing on L side, so L leg crosses over R leg)

What is the DS for SAR/SAL Thompson?

Scissored stance slightly inferior to articulation on the side OPPOSITE of apex deviation

What is the SCP for SAR/SAL Thompson?

1) Sacral notch on side of apex deviation

2) Medial portion of PSIS on side of apex deviation

What is the LOC for SAR/SAL Thompson?

P-A

and R-L or L-R (depending on listing)

What is the TQ for SAR/SAL Thompson?

SAL = CCW

SAR = CW